Percutaneous Transluminal Angioplasty for Atherosclerotic Stenosis of Vertebral Artery Origin

Area of Science:

• Vascular Surgery
• Interventional Neurology
• Cardiovascular Medicine

Background:

• Limited data exists on percutaneous transluminal angioplasty (PTA) or PTA with stent placement (PTAS) for vertebral artery origin (VAO) stenosis in patients with other narrowed cerebral arteries.
• Understanding the impact of polystenotic lesions and concomitant carotid artery stenting (CAS) on PTA/S outcomes for VAO stenosis is crucial.

Purpose of the Study:

• To evaluate the periprocedural risks and long-term effects of PTA/S for atherosclerotic VAO stenosis.
• To determine if multiple stenoses or concurrent CAS influence the safety and efficacy of VAO PTA/S.

Main Methods:

• Retrospective study of 66 patients with ≥70% VAO stenosis treated with PTA/S.
• Patients categorized into isolated VAO stenosis and multiple stenoses groups.
• Analysis of periprocedural complications (72 hours) and long-term restenosis, ischemic stroke (IS), and transient ischemic attack (TIA) rates.

Main Results:

• Polystenotic lesions were present in 84.8% of patients; 31.8% had additional endovascular treatment, including CAS in 15 patients.
• No periprocedural IS or deaths occurred; one TIA (1.6%) was observed in the polystenotic group with CAS.
• Mean follow-up of 36 months revealed 16.3% asymptomatic VA restenosis and 8.9% IS in the polystenotic group.

Conclusions:

• The presence of severe polystenotic lesions does not increase the periprocedural risk of PTA/S for VAO stenosis.
• Concomitant CAS in patients with polystenotic lesions does not adversely affect the safety of VAO PTA/S.
• PTA/S for VAO stenosis demonstrates a low periprocedural risk and favorable long-term outcomes regarding restenosis, even in complex cases.